European Journal of Case Reports in Internal Medicine <p><strong>The&nbsp;<span class="HPblu">European Journal of Case Reports in Internal Medicine</span>&nbsp;</strong>is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from&nbsp;<a href="">33 European countries</a>.&nbsp;<br><br>The journal’s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field.&nbsp;<strong><br><span class="HPblu">EJCRIM&nbsp;</span></strong>welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight, contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors).&nbsp;<strong><br></strong>The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.<br><br> <strong>EJCRIM</strong> is peer-reviewed with single-blind review and freely accessible to all.</p> SMC media s.r.l. - Via Giovenale 7, Milan - Italy en-US European Journal of Case Reports in Internal Medicine 2284-2594 <h3>Copyright and Disclosures</h3> <p>Every author must sign a copyright transfer agreement and disclose any financial or professional interest in any company, product, or service mentioned in an article. This authorization includes all submitted text including illustrations, tables, and other related materials.<br> If this submission contains any <strong>material that has been previously published</strong>, this authorization <strong>must also be accompanied</strong> by all necessary Permission to Reproduce Published Material" forms completed by the current copyright owner. If this submission contains any <strong>previously unpublished material</strong> for which the person(s) signing this form <strong>does not own copyright</strong>, an additional "Authorization to Publish" form is required from each corresponding copyright owner.</p> <h3>Copyright Transfer Declaration</h3> <p>(this may be included as a word document with your manuscript submission)<br> I confirm that I am the current copyright owner of the material described above and hereby transfer and assign to the European Journal of Case Reports in Internal Medicine (EJCRIM) all copyrights in and to the material for publication throughout the world, in all forms and media, in English and in any other language(s). Such transfer includes publication in this and all future editions of the publication named above and in any other publications (including slide collections and any other nonprint media) of EJCRIM and gives EJCRIM the sole authority to grant rights for use of the material by others.<br> I waive EJCRIM from any liabilities connected to the incorrect copyright statement.<br>The copyright agreement form can be downloaded <a style="font-weight: bold;" href="/documents/EJCRIM_Copyright_auth.pdf">HERE</a> or requested to the editorial office <a style="font-weight: bold;" href=""></a></p> Reccurrence of Graves’ disease (a Th1-type cytokine disease) following SARS-CoV-2 mRNA vaccine : a simple coincidence ? <p>Graves’ disease is the most frequent cause of hyperthyroidism in young women. This auto-immune disease is due to the production of class 1 IgG stimulating the TSH receptor. These antibodies are produced secondary to a Th1 immune response in which interferon ? plays a key role. Vaccination is ongoing worldwide against SARS-CoV-2 and some of the vaccines used are from mRNA which seems to stimulate the TH-1 immune response. Here, we report a case of recurrence of hyperthyroidism due to Graves’ disease following mRNA vaccination and discuss the possible implicated mechanism. This observation argues for a systematic study of a population of patients with previous Graves’ disease in order to assess the risk of recurrence following vaccination.</p> Guillaume Pierman Etienne Delgrange Corinne Jonas Copyright (c) Pulmonary nodules in elderly patient with pancreatic cancer <p>Pulmonary histoplasmosis is a fungal infection that can show itself in many different forms, especially in immunocompromised individuals. Its nodular form has a special importance due its differential diagnosis with pulmonary metastasis. We present a case of a 84-year-old male with a pancreatic adenocarcinoma and multiple pulmonary nodules, being diagnosed with pulmonary histoplasmosis</p> Marcus Villander Sá Bianca Castelo Branco Rocha Flávio Pacheco Jorge Carvalho Gustavo Miranda Luydson Vasconcelos Copyright (c) Guillain-Barré syndrome as rare initial manifestation of esophageal carcinoma <p>Polyneuropathies may be part of a paraneoplastic syndrome as the first symptom of a carcinoma. The investigation of an occult neoplasm should be part of the etiological investigation of neurological syndromes of undetermined etiology. The relationship between Guillain-Barré syndrome (GBS) and malignancy is still controversial and, to our knowledge, there are only two previous reports of GBS associated with esophageal carcinoma. We describe the third case of a possible relationship between GBS and esophageal carcinoma.</p> <p>Keywords: Esophageal carcinoma, Guillain-Barré syndrome, Paraneoplastic neurological syndromes.</p> Maria Duarte Raquel Rocha Filipe Correia Copyright (c) Pulmonary involvement responsive to enzyme replacement therapy in an elderly patient with Gaucher disease <p>Type 1 Gaucher disease (GD) is a rare autosomal recessive lysosomal storage disorder caused by a deficient activity of beta-glucocerebrosidase, leading to an accumulation of its substrate (glucosylceramide) into macrophages of the reticuloendothelial system, then referred to as Gaucher cells. The most frequent symptoms are asthenia, spleen and liver enlargement, bone abnormalities and cytopenia due to bone marrow infiltration. Lung involvement in GD is a rare finding, and it is unclear whether it may regress under enzyme replacement therapy (ERT) or substrate reduction therapy (SRT). Here we report the case of a type 1 GD lately diagnosed in an elderly patient complicated by infiltrative lung disease, which responded to ERT.</p> Pascal Cathébras Baptiste Gramont Dylan Vellas Rémi Grange Copyright (c) Non specific interstitial pneumonia revealing an antisynthetase syndrome <p>Non specific interstitial pneumonia (NSIP) is one of the most identified interstitial lung disease in antisynthetase syndrome. This case is about a 49 years old woman who presented with an exertional dyspnea that has a slow progression, with myalgia and arthralgia. Radiological findings suggested NSIP pattern. Auto antibodies were positive and no lung biopsy was performed. Eventhough there was a great improvement of the dyspnea under corticosteroid therapy, the patient developed mecanic’s hands, the anti-synthetase antibody (PL12) became positive and creatine phosphokinase (CPK) levels became high. Thus, antisynthetase syndrome was confirmed. After three years, the patient follow up showed an improvement of symptoms under corticosteroid therapy</p> Nadia Moussa Rahma Gargouri Mouna Snoussi Rym khemakhem Zouhir Bahloul Samy Kammoun Copyright (c) MALE - CATASTROPHIC ANTIPHOSPHOLIPID ANTIBODY (CAPS) SYNDRONME <p>Antiphospholipid antibody syndrome leads thrombophilia manifest as venous and arterial thrombosis with pregnancy loss in the presence of persistent antiphospholipid antibody. It’s a disease is which is more common in female. CAPS is the fatal variant of APS in which 3 or more organs are involved with multi-organ failure in a short period of time with high rate of morbidity and mortality.</p> <p>We present an unusual case of south-east Asian young male who’s a known case of leprosy on treatment presented with multiple left renal infarcts, multiple splenic infarcts, pulmonary thromboembolism, and inferior mesentery artery thrombosis with bowel ischemia. Patient have positive B2GP1 antibodies, dilute Russell`s viper venom. In spite of start on low molecular weight heparin, anti-platelets and intravenous immunoglobulin (IV Ig) patient could not be survived. The aim of the case presentation is to remember the clinical scenario, lab parameter and aggressive management required in the case of patient in ICU.</p> Dr Mukesh Bairwa Paras Gupta Jithesh G Ravi Kant Copyright (c) A Rare Case of Guillain-Barré Syndrome following COVID-19 vaccination <p>As Covid-19 cases surge exponentially since March 2020, the hunt for a safe and effective vaccine becomes the need of the hour. With the development of various vaccines and the conclusion of clinical trials by December 2020 and their emergency administration in healthcare settings, numerous adverse effects have been noted despite being termed safe during the clinical trials. A case of Guillain-Barré Syndrome (GBS) following the Covishield vaccination is presented here to highlight the possibility of developing this adverse condition.</p> Yash Kripalani Lipeeka Parulekar Vidyadhara Lakkappan Anjum Shaikh Rakesh Singh Pradeep Vyas Copyright (c) Rhabdomyolysis following administration of Comirnaty – a case report <p>Introduction: Vaccination for COVID-19 is essential to tame the pandemic. The vaccines developed have good safety profiles but the full knowledge of its adverse effects’ profile will only be built with time and through case reports.</p> <p>Case Description: We present a case of a man admitted with rhabdomyolysis three days after taking the first dose of the coronavirus Pfizer vaccine - ComirnatyÒ. Other causes for rhabdomyolysis – traumatic, infectious, endocrine, electrolyte disturbances and autoimmune – were excluded. The temporal relationship between the administration and the event favored possible causality. The patient had favorable evolution with fluids and normalized completely. To our knowledge, there are only 69 reports of rhabdomyolysis following ComirnatyÒ in Europe, according to European Medicines Agency, and this is the first case report in Portugal.</p> <p>Discussion: When a patient presents with rhabdomyolysis without obvious traumatic or exertional setting, other etiologies need to be excluded. One of the most common causes of rhabdomyolysis in the adult population are drugs.</p> <p>Conclusion: We present a case compatible with an adverse effect of ComirnatyÒ and hope to raise awareness for and adverse effect that should be remembered if symptoms are reported.</p> Catarina Elias Pedro Cardoso Diana Gonçalves Inês Vaz Leila Cardoso Copyright (c) Cushing Syndrome Behind Hypokalemia and Severe Infection – a Case Report <p>Introduction: Cushing’s syndrome (CS) is a rare condition associated with increased morbidity and mortality. Complications derive from hypercortisolism and are mainly cardiovascular, infectious and thrombotic. Most manifestations are unspecific and the diagnosis is frequently delayed and made only in the setting of complications.</p> <p>Case Description: We present a woman in whom CS was investigated because of refractory hypokalemia, hypernatremia and metabolic alkalosis. The patient had several cardiovascular risk factors and was hospital admitted due to a severe bacterial infection – muscle abscesses evolving to osteomyelitis. The final etiological diagnosis was not possible because the acute event had a fatal outcome.</p> <p>Discussion: Hypercortisolism-associated immunosuppression renders patients prone to severe infectious conditions. Infectious complications are an important cause of death in CS.</p> <p>Conclusion: Early diagnosis and treatment of CS is the key to prevent its dismal complications.</p> Catarina Elias Diana Oliveira Maria Manuel Silva Catarina Novais Sofia Alves Patrícia Lourenço Copyright (c) Euthyroid sick syndrome in an asymptomatic patient leads to an interesting diagnosis <p><u>Background</u></p> <p>Euthyroid sick syndrome in which low peripheral thyroid hormones are found combined with normal TSH is frequently observed in the intensive care unit or in patients with other well defined severe underlying pathology.</p> <p>We describe an asymptomatic patient with this syndrome. This presentation leads to the surprising diagnosis of an aggressive multiple myeloma.</p> <p><u>Case Description</u></p> <p>A 73-year-old patient without relevant medical history gets referred by his general practitioner to the endocrinologist because of the repetitive observation of low peripheral thyroid hormone levels with normal TSH levels. The patient is asymptomatic. Additional investigation is conducted including an extensive blood work. Due to the finding of a monoclonal gammopathy on electrophoresis the diagnosis of an aggressive multiple myeloma was ultimately made.</p> <p><u>Conclusion</u></p> <p>Asymptomatic patients who present with euthyroid sick syndrome could have underlying multiple myeloma. Conducting an electrophoresis early could be helpful in coming to the diagnosis.</p> Julien Duyck Jan Van den Saffele Xavier Aers Dries Deeren Katrien Spincemaille Copyright (c)